USC team first to perform high-level kidney cancer surgery using robot

Inderbir Gill, chair of the Catherine and Joseph Aresty Department of Urology, is founding executive director of the USC Institute of Urology. (Photo/Philip Channing)

Keck Medicine of USC surgeons with the USC Institute of Urology used the daVinci Xi robot to perform a complex kidney cancer operation that cuts the patient’s recovery time of two to three weeks to four to five days.

The three-and-a-half hour surgery, performed on Nov. 21 at Keck Hospital of USC, removed a 4-inch kidney cancer tumor that had grown into 67-year-old Philip Braden’s inferior vena cava (IVC), a critical supplier of deoxygenated blood from the lower half of the body to the heart.

The tumor, called an IVC thrombus, was classified level II/III and is among the most challenging tumors to remove from the body.

The surgery was the 12th level II/III surgery performed by Inderbir Gill, executive founding director of the USC Institute of Urology, and his team. A portion of the procedure was broadcast live to the 92nd annual meeting of the Society of Genito-Urinary Surgeons at USC Norris Comprehensive Cancer Center.

The shorter recovery time offered by the Xi robot was key for Braden, who also was diagnosed with a large tumor attached to his spine and faces additional surgery, Gill said.

“A level III IVC thrombus is usually removed via major open surgery because of its complexity,” he explained. “To date, USC Institute of Urology surgeons are the only ones in the world to perform level III IVC thrombectomy surgery with the robot. With a quicker recovery time, he will be able to move faster to the next steps in cancer surgery and treatment. Understandably, he wants to be cancer-free as soon as possible.”

Increasing back pain led to surgery

Braden, an Agoura resident, learned on Halloween that he had cancer of the kidney and the spine after more than four months of increasingly debilitating back pain. He had been trying to manage the pain with over-the-counter painkillers, even during an autumn cruise to Europe with friends.

I’m a lucky man.

Philip Braden

“I’m still trying to get my mind around the diagnosis,” said Braden, who is retired. “I thought I was dead when my oncologist told me about the tumors, but he said I could survive and referred me to Dr. Mihir Desai and Dr. Gill. I’m a lucky man because I’m in Los Angeles, and I found two of the best doctors in the world.”

Four to 10 percent of all kidney cancers are associated with IVC thrombus. Kidney cancer is the most common urologic cancer in the United States. Nearly 14,000 Americans are expected to die of kidney cancer in 2014, according to the American Cancer Society.

Braden’s tumor had grown from his right kidney into the inferior vena cava, heading up toward his heart. After removing the kidney and surrounding lymph nodes, Gill, Desai and their team isolated the tumor within the IVC, sliced open the vein and cut out the tumor.

The Xi robot has smaller arms than other robots used for surgery, which gives surgeons greater dexterity and a larger operating field without having to reposition the robot as frequently throughout the procedure. For qualifying patients, the result is typically smaller incisions leading to less pain, minimal scarring and bleeding, less need for medication, shorter hospital stays and faster recovery.

“This procedure pioneered by our institute opens the door for other minimally invasive abdominal surgery in the future, including for the liver and colon,” Gill said.